The University of Washington Medical School (UW-MS) serves as the sole medical educational resource for 5 states in the Northwest US: Washington, Wyoming, Alaska, Montana, and Idaho. In addition, to its educational mission, the UW-MS is also recognized as a major institution in biomedical research in the US and consistently ranks amongst the top 10 medical schools in receipt of federal research funding. Within the UW, the Division of Gastroenterology of the Department of Medicine, composed of a core of 25 faculty members, operates from five medical centers: the University of Washington Health Sciences Center, the Puget Sound Veterans Affairs Health Care System, the Harborview Medical Center, the Fred Hutchinson Cancer Research Center, and Pacific Medical Center. This diversity allows the research and clinical programs of the Gl Division to benefit from complementary strengths, ranging from tertiary referral centers (e.g. UWHSC, PSVAHCS) to primary care centers in urban (e.g. PMC) or rural (outreach programs in Alaska, Montana, and Idaho) settings, and from highly specialized centers (e.g. FHCRC) to broadly diversified county medical centers (e.g. HMC). Benefiting from these strengths, the Gl Division at the UW-MS has had a long tradition of training academic fellows, dating to the 1950's. Indeed, over the last 25 years, more than 40 graduates of the Gl fellowship program have joined academics. Of those, many have assumed leadership positions in their respective fields. Over the past 5 years, the University of Washington NIH Training Grant in Digestive Diseases has helped the training of 5 Gl fellows on the physician-scientist tract and of 7 MD's and/or Ph.D.'s interested in GI research. In this renewal application, the objectives of the Training Grant remain unchanged: rigorous training for a research career in academic Gl. This goal will be achieved through the following features offered by this Training Grant: 1. A strong program faculty composed of 23 preceptors, 3 associate preceptors, and 6 co-preceptors. This faculty includes members of 2 additional Divisions within Medicine and 9 Departments within the UW-MS, who all have collaborated with our Gl Division. In the aggregate, this Training Faculty includes two members of the NAS and Lasker award winners, and hold upwards of 30 NIH RO1/PO1/UO1 or VA Merit Reviews. 2. A structured training program in Carcinogenesis &Molecular Genomics, Cell and Molecular Biology, and with revised and enhanced training in Epidemiology and Clinical Outcomes